Nursing Objectives Extended

1. Which organism is a common opportunistic infection in a client infected with human immunodeficiency virus (HIV) a. Oropharyngeal candidiasis b. Most common infection associated w/ HIV b/c immune system can no longer control candida fungal growth i. (PCP) → common in AIDs ii. Cryptosporidiosis → intestinal infection in AIDs patients iii. Toxoplasma gondii → encephalitis common in AIDs patients 2. What type of help could a nurse provide for a client that is showing physical symptoms of stress? a. Teach the patient a new coping mechanism 3. What type of rehabilitation is an essential component to a client’s recovery from Guillan-Barre syndrome? a. Physical therapy b. Rehabilitation needs for a pt focus on physical therapy & exercise for the lower extremities b/c of muscle weakness and discomfort i. Doesn’t need speech or swallowing exercises ii. Doesn’t need vertebral support iii. No problems w/ cataracts 4. Which technique would be appropriate for clients who exhibit mild neurocognitive impairment? a. Reality orientation b. Reality orientation → technique to use w/ clients who have mild neurocognitive impairments i. Generally helpful for clients exhibiting mild neurocognitive impairment → clients are aware of their impairment and orientation then reduces anxiety 5. Which statement accurately described a health care policy as it relates to healthy care economics? a. It provides overarching goals and help in setting priorities & values for the distribution of health resources b. Health care policy → provide overarching goals and helps in setting priorities and values for distribution of health resources i. Health care quality → issues surrounding standards of care and health care outcomes ii. Health care coordination → collaboration between health care professionals and other resources, which are required to deliver client care iii. Health care law → governing factor in health care economics and play vital role in the application of health care funding & reform 6. Which action by the nurse would be the priority for a male client with a history of schizophrenia who comes to the emergency department accompanied by his spouse? a. Observing & evaluating his behavior b. The client and his needs are the priority → assessment is the 1st step of the nursing process i. Writing a plan of care for the mental health team → done after a thorough assessment is completed ii. Nurse must deal with the present, not the past → no need for past medical records iii. Meeting separately w/ the wife should be done → not the priority & can be done at a later time 7. Prednisone is prescribed for a client with an exacerbation of colitis. Which explanation would the nurse provide for administering prednisone? a. Although the medication decreases intestinal inflammation, it will not cure colitis b. Prednisone → inhibits phagocytosis & suppresses other clinical phenomena of inflammation -----> symptomatic treatment; not curative i. Medication response → rapid ii. Medication suppresses the immune response & increases the potential for infection iii. Appetite is increased → weight gain may result from this or from fluid retention 8. A client reports left-sided chest pain after playing racquetball. The client is hospitalized and diagnosed w/ left pneumothorax. When assessing the client’s left chest area, the nurse expects to identify which finding? a. Absence of breath sounds on auscultation b. Left lung is collapsed → no breath sounds i. Tympanic sound will be heard w/ pneumothorax ii. No vocal fremitus b/c there’s no airflow into the left lung as a result of pneumothorax iii. Rales w/ rhonchi will not be heard b/c there’s no airflow into the left lung as a result 9. While awaiting surgery, a client w/ a history of Crohn disease is receiving total parental nutrition (TPN) on an outpatient basis. The nurse teaches the client that TPN helps prepare for surgery by which process? a. Decreasing fecal bulk b. By decreasing fecal bulk & bowel stimulation → TPN provides rest for the bowel while the client awaits surgery i. Doesn’t prevent bowel infection ii. Doesn’t stimulate GI secretions iii. Promotes positive nitrogen balance 10. Which sign in the newborn infant would reflect an Apgar score of 1 in the category of respiration? a. Slow, weak cry b. Slow weak cry would be scored as a 1 in the category of respiration in the Apgar scoring system i. Good cry → 2 ii. Grimace → evaluated as category of reflex irritability, not respiration iii. Absent respiration → score of 0 in respiration category 11. According to Kubler-Ross theory of death and dying, which stage is a terminally ill client displaying by gradually moving towards resolution of feelings about impending death? a. Acceptance stage b. When acceptance is reached → individual is beginning to withdraw form life i. Communication is simple, concise, and most often, NONVERBAL ii. Verbal communication less important → touch & presence are most important 12. The nurse providing postoperative care for a client who had kidney surgery review the client’s urinalysis report. Which urinary finding indicates the need to notify the primary health care provider? a. Presence of large protein b. Glomeruli aren’t permeable to large proteins such as albumin or RBC → finding them in urine is abnormal & nurse needs to report to the primary health care provider about modifying the treatment plan 13. Which statement must the nurse emphasize to the family when preparing a school-aged child w/ persistent asthma for discharge/ a. Medications must be continued even when the child is asymptomatic b. Children w/ persistent asthma → must continue taking medications to keep them asymptomatic 14. Which key feature is associated w/ stage 2 pressure ulcer? a. Presence of nonintact skin b. Skin is nonintact in stage 2 of pressure ulcers i. Stage 4 → presence of sinus tracts ii. Stage 3 → subcutaneous tissue becomes damaged or necrotic iii. Stage 1 → reddened area over a bony prominence 15. After cataract surgery, a client reports feeling nauseated. How can the nurse prevent vomiting? a. Administer the prescribed antiemetic medication b. Antiemetic → will prevent vomiting i. Vomiting increases intraocular pressure and should especially be avoided in a cataract pt 16. Which type of continuing care would a clint expect if discharged home w/ an infusion device to continue treatment for a leg wound? a. Home care b. Clients who are discharged w/ an infusion device to continue medication therapy at home should expect home care services to teach appropriate administration of medication therapy in client’s home 17. Which type of group is alcoholic anonymous (AA)? a. Self-help group b. AA → self-help group of ppl who meet to attain & maintain sobriety i. Social group → building interpersonal relationships through participation in mutual activities ii. Resocialization group → increasing social skills that may be diminished or lacking iii. Psychotherapeutic group → treat mental & emotional disorders w/ use of psychological techniques & always has member of the health profession as it’s leader 18. Which is appropriate for the nurse to include in the education of the ethical principal of nonmaleficence to a group of nursing students? a. Act in ways to prevent harm to clients b. Nonmaleficence → act in wayss that prevent client harm or even risk of harm i. Veracity → telling truth to client ii. Autonomy → helping client make informed choices iii. Justice → treating all clients equitably & fairly 19. Which condition is an example of bacterial infection? a. Impetigo b. Bacterial infection caused by Group A B-hemolytic streptococci or staph aureus 20. Which cardiovascular adverse effect would the nurse with the use of clomiphene? a. Tachycardia b. Clomiphene → used to induce ovulation → cause tachycardia 21. According to Erikson’s psychosocial stages of development, which stage must a 3-year old accomplish? a. Autonomy vs. Shame b. About acquiring mastery over self and environment i. Infancy → trust vs. mistrust ii. Middle childhood → Industry vs inferiority iii. Middle adulthood → generativity vs. stagnation 22. Which test provides information on bladder capacity, bladder pressure, and voiding reflexes? a. Cystometrography (CMG) b. CMG → urodynamic study that provides info on the bladder capacity, bladder pressure, & voiding reflexes i. Radiography → diagnostic test for clients w/ disorders of kidney and urinary system to screen for presence of 2 kidneys, measure kidney size, & to detect gross obstruction in kidneys or urinary tract ii. Renal arteriography → diagnostic study used to determine rneal blood vessel size and abnormalities iii. Emg → urodynamic study used to test the strength of perineal muscles in voiding 23. Which is the middle layer of the eyeball? a. Uveal tract b. Consists of the iris, choroid, & ciliary body → middle layer of the eyeball i. Sclera → part of the tough outer layer of the eyeball ii. Retina → innermost layer of the eyeball iii. Transparent cornea → outermost layer 24. Which team member acts as a liaison between the health care faciluty and the media? a. Public information officer b. Acts as a liason i. Triage officer → applies disaster triage tags after evaluating client’s condition ii. Medical command physician → decides the #, acuity, and resource needs of clients iii. Hospital incident commander → assumes overall leadership for implementing emergency plan 25. The spouse of a client w/ TB received a tuberculin skin test. The nurse examined the skin test and identified an area of induration greater than 10 mm. Which response to this finding would the nurse implement? a. Additional tests are necessary to determine infection status b. Tuberculin skin test doesn’t indicate whether TB is dormant or active → induration of 5 mm or greater is POSITIVE i. w/ disease causing decreased resistance → require further diagnostic study (chest x-ray/ sputum culture) 26. The nurse leader is teaching the staff that the health care provider strives to work effectively within the cultural context of a client. Which cultural principle is the nurse leader explaining? a. Cultural competence b. Process where HCP strives to achieve the ability to work effectively w/in the cultural context of client, individual, family, etc i. Cultural diversity → vast range of cultural differences among individuals or groups ii. Cultural sensitivity → affective behaviors of individuals such as the capacity to feel, convey, and react to ideas, habits, and customs or traditions iii. Cultural imposition → tendency of an individual or group to impose their values, beliefs, and practices on another culture for various reasons 27. Which is the nurse demonstrating when labeling the African-American client a drug abuser for requesting pain medication? a. Ethnocentrism b. Tendency of a person to hold his or her own beliefs superior to those of other people → causes biases and prejudices in regard to people from other groups Hyperplasia - increase in number of cells - Results from increased physiologic demand or hormonal situation - Persistent injury may also lead to this Metaplasia - replacement of 1 differentiated cell type w/ another - Adaptation to persistent injury w/ replacement cell better able to withstand current stress - Fully reversible when stimulus removed - Often include replacement of glandular epithelium w/ squamous epithelium - Still remain generally well differentiated and of the same tissue type but cancerous transformations could occur Dysplasia - abnormal variations in size, shape, and arrangement - Occur most frequently in hyperplastic squamous epithelium - Also seen in mucosa in intestine - Represents adaptive effort gone wrong - Sig. potential to transform into cancerous cells - preneplastic lesions - Carcinoma in situ - dysplasia that’s sever and involves entire thickness of epithelium - Mild form may be reversible if stress is removed Irreversible cell injury: - 2 different process: 1. Necrosis - consequence of ischemia or toxic injury and characterized by cell rupture 2. Apoptosis - resposne to injury that doesn’t kill cell, but triggers intracellular cascades that activate a cellular suicide a. Do not rupture and are injested by neighboring cells w/ minimal disruptions and w/out inflammation b. Not always pathologic process i. Could occur as necessity of development and tissue remodeling Necrosis - Typical morphologic changes - shrunken nucleus, swollen cell volume, dispersed ribosome, and disrupted plasma and organelle membranes - Disruption of permeability of plasma membrane is critical event in death of cell - Presence of specific cellular proteins can be used for location and extent of cellular death - 4 types of necrosis: 1. Coagulative - most common a. Ischemic cellular death b. Loss of plasma membrane’s ability to maintain electrochemical gradient c. Influx of calcium ions and mitochondrial dysfunction d. degradation of plasma membrane and nuclear structures - Coagulated is denatured proteins and mostly solid - Slowly dissolved by proteolytic enzymes and general tissue is preserved for relatively long times 2. Liquefaction - area of lysomal enzymes and dissolved tissue that forms abscess or cyst a. May result from trigger of wbc, which contain degraditive enzymes that digest cells, etc 3. Fat necrosis - death of adipose tissue from trauma or pancreatitis a. Release of activated digestive enzymes from pancreas or injured tissue b. Ezymes attack cell membrane of fat cells, releasing their store of triglycerides c. Pancreatic lipase hydrolyzes the triglycerides which appears like chalky white area 4. Caseous necrosis - characteristic of lung tissue damaged by tuberculosis a. Resembles clumpy cheese 5. Gangrene - cellular death involving a large area of tissue a. Usually results form interruption of major blood supply to particular body part b. Could be dry gangrene, wet gangrene, or gas gangrene a. Dry gangrene - blackened, dry, wrinkled tissue that’s separate from adj. Healthy tissue by obvious line of demarcation i. Usually occurs in extremities b. Wet gangrene - liquefactive necrosis usually found in internal organs i. Appear cold and black, and may be foul smelling due to invasion of bacteria 1. Could rapidly spread and cause toxins to be released in blood stream c. Gas gangrene - formation of bubble of gas in damaged tissue i. Result of infection of necrotic tissue by anaerobic bacteria of the genus Clostridium 1. Bacteria produce toxins and degradative enzymes that spread through necrotic tissue Apoptosis - activated cell death from lack of control in cell division and rate of cell death - Tidy and doesn’t cause inflammation - Primary factor in disease such as heart failure and dementia - May be triggered by “withdrawal” of “survival” signals that suppress the apoptic pathways - Cell death cascade activated - Fas ligand bind to the cell and trigger death cascade through activation of “death receptors” - Can be triggered by internal pathways - Pathway governed by p53 protein (amount is normally quite low but increases in cellular DNA damage) - High amount results in apoptosis - prevents multiplying of cells w/ dna damage - Cancer is related to mutation in p53 gene - Capases is the main component of proteolytic cascade that degrades key intracellular structures leading to cell death - Proenzymes that are activated in cascade - Activation of few initiators capaes in beg. results in rapid domino effect - Some capses cleave key proteins - Need atp to be present in cell - Neurotransmitters and receptors of the ANS: - Parasympathetic division - Neurotransmitter - - Acetylcholine (Ach) - Receptors - Nicotinic (N2) - Muscarinic (M1 - M5) - Location - Nicotinic (N2) => Ganglionic neurons (excitation) - Muscarinic (M1 - M5) => Parasympathetic target organs (excitation) - Sympathetic Division - Neurotransmitter - Norepinephrine (NE) - Epinephrine - Receptors - 𝛃1 - 𝛃2 - 𝞪1 - 𝞪2 - Location - 𝛃1 => Heart; Kidneys - 𝛃2 => Lungs (bronchiole dilation) - 𝞪1 => vasoconstriction of blood cells (increases blood pressure) - No parasympathetic innervation - 𝞪2 => Axon terminals (autoreceptors) - NANC ( non-noradrenergic/non-cholinergic transmitters - Main ones: - Nitric oxide and vasoactive intestinal peptide (parasympathetic) - ATP and neuropeptide Y (sympathetic) - Others, such as - 5-hydroxytryptamine (5HT) - GABA and dopamine - Co-transmission is a general phenomenon - Central Nervous System ● 2 types of cells in the nervous system ○ Neurons (nerve cells) - electrical signalling (about 10% of all cells in the brain) ○ Gila (neuroglia) - support cells (about 90% of all cells in the brain) ● Glial Cells in the CNS ○ Astrocytes - (most abundant and important) ■ Excess K+, neurotransmitters ■ Isolate axon terminals (restrict spread of neurotransmitters) ■ Structural support for neurons/influence how neurons grow ■ Participates in metabolic pathways with neurons; modulate neurotransmitters, ions and metabolites ● Ex. Glutamate recycling ■ Regulation of extracellular (K+) ● If extracellular potassium increases, it can cause depolarization of neurons ● Normal levels is 4-5 mm ■ Synaptogenesis (development of synapses) ■ Regulation of synaptic transmission ○ Microglia - (smallest glial cell) ■ Macrophages (immune system and phagocytosis) ○ Ependymal cells - (ciliated) ■ Line the epithelium of the ventricles of brain and spinal cord ● Filled with fluid which is very similar to plasma ■ Have cilia which helps move cerebral spinal fluid through ventricles ■ ○ Oligodendrocytes ■ Produce myelin ● Myelin ○ 80% lipid ○ 20% protein ○ Provides insulation for fast conduction of action potentials ■ Purpose is to save space in the brain ● Able to wrap up to 50 axons ● Glial Cells in the PNS ○ Schwann cells ■ Produce myelin ■ Each schwann cell wraps only one neuron ● Brain: major regions ○ Cerebrum (cerebral hemisphere) ■ 3 basic regions of each hemisphere: ● Cortex,white matter, basal nuclei ■ 4 lobes of the cerebrum: ● Frontal ○ Precentral gyrus